This is the first case of consecutive patients undergoing ambulatory colectomy for malignant or benign disease. We demonstrated the feasibility, safety, and reproducibility of outpatient colectomy for selected patients. In our experience, 30% of patients scheduled for elective colectomy can be managed in an ambulatory setting.

Portal vein thrombosis (PVT) has been seen as an obstacle to orthotopic liver transplantation (OLT), but recent data suggest that favorable results may be achieved in this group of patients. The aim of this study was to analyze the incidence, management, and survival of patients with PVT undergoing primary OLT with thrombectomy. Between October 1990 and August 2000, 468 liver transplantations were performed in our center and portal vein thrombosis was present in 38 patients (8.1%). Preoperative diagnosis, extension, intraoperative management, postoperative recurrence of portal vein thrombosis, and 1-year actuarial survival rates were retrospectively studied. Preoperative diagnosis was made in 17 cases (44.7%). In all patients, portal flow was restored after portal vein thrombectomy, followed by usual end-to-end portal anastomosis. All patients received preventive low-weight heparin from day 2 to hospital discharge, and then aspirin. Rethrombosis was observed in one patient with extended splanchnic thrombus. The 1-year actuarial patient survival rate was 83.7%, and did not significantly differ from the patients without portal vein thrombosis (86.7%). Our results suggest that portal vein thrombosis is often partial and thus difficult to diagnose preoperatively; it can be managed successfully during surgery by thrombectomy, except when there is complete splanchnic veins thrombosis; and it did not affect 1-year survival.

Background The implementation of an Enhanced Recovery After Surgery programme after colectomy reduces postoperative morbidity and shortens the length of hospital stay. Objective To evaluate the short and midterm outcomes of ambulatory colectomy for cancer. Methods This was a two‐centre, observational study of a database maintained prospectively between 2013 and 2021. Short‐term outcome measures were complications, admissions, unplanned consultations and readmission rates. Midterm outcome measures were the delay between surgery and initiation of adjuvant chemotherapy, length of disease‐free survival and 2‐year disease‐free survival rate. Results A total of 177 patients were included. The overall morbidity rate was 15% and the mortality rate was 0%. The admission rate was 13% and 11% patients left hospital within 24 h of surgery. The readmission rate was 9% and all readmissions occurred before postoperative Day 4. Eight patients underwent repeat surgery because of anastomotic fistula (n = 7) or anastomotic ileocolic bleeding (n = 1). These patients had an uneventful recovery. Sixty‐one patients required adjuvant chemotherapy with a median delay between surgery and chemotherapy initiation of 35 days. Conclusions Ambulatory colectomy for cancer is feasible and safe. Adjuvant chemotherapy could be initiated before 6 weeks postsurgery. The ambulatory approach may be a step forward to further improve morbidity and oncologic prognosis.

The program was equally safe with both procedures. Postoperative antithrombotic heparin does not appear necessary in low-risk patients. Bariatric surgical ERAS programs are evolving and not yet standardized.

BackgroundAppendectomy is increasingly performed as a ‘short stay’ or ‘ambulatory’ procedure, yet there is no consensus for selection of patients with acute appendicitis for ambulatory surgery (AS). We aimed to compare characteristics and outcomes of complicated and uncomplicated appendectomies performed in ambulatory vs. conventional settings, and to determine factors associated with unexpected re-consultations and re-hospitalizations.MethodsThe authors reviewed a consecutive series of 185 laparoscopic appendectomies. Whenever possible, patients were offered AS, defined as ‘discharge on the same working day.’ Multivariable regressions were performed to determine associations of unexpected re-consultations and re-hospitalizations with surgery type (ambulatory or conventional) and patient characteristics (age, gender, obesity, symptoms, appendicolith, perforations, appendix diameter, serologic results, American Society of Anesthesiologists score, and Saint-Antoine score).ResultsFrom the initial cohort, 117 patients (63.2%) were eligible for AS, of which 8 had peri- or post-operative contraindications. Therefore, 109 patients (58.9%) were operated by AS, with median length of stay 8.5 h (range, 3.3–20.5). Ambulatory cases had a lower incidence of complications (11.9%) than conventional cases (25.0%) (p = 0.029). Uni- and multi-variable regressions revealed that unexpected re-consultations were not significantly associated with any of the pre- or peri-operative variables but that unexpected re-hospitalizations were 4 times more likely for patients with appendicolith (OR, 4.32; p = 0.04).ConclusionsAmbulatory surgery could be considered as a standard procedure for both complicated and uncomplicated acute appendicitis. Appendicolith was found to be an independent risk factor for unexpected re-hospitalization and should therefore trigger closer monitoring.